361880736-2-22-2023-56-AS-KCLS-CPCU4E-20230224141458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880736
Report Date: 02/22/2023
Date Signed: 02/22/2023 01:34:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2023 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230207154955

FACILITY NAME:	VILLA'S ADULT RESIDENTIAL HOME		FACILITY NUMBER:	361880736
ADMINISTRATOR:	DRAYTON MCCALL, SHERRY		FACILITY TYPE:	735
ADDRESS:	11262 VILLA ST		TELEPHONE:	(760) 523-1607
CITY:	ADELANTO	STATE: CA	ZIP CODE:	92301
CAPACITY:	3	CENSUS: 1	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Sherry Drayton-McCall, Licensee		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Resident's cigarettes are taken away by staff when resident has behavior issues
Residents outings are taken away by staff when resident has behavior issues
Staff pulls residents hair
Staff does not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA met with Licensee Sherry Drayton-McCall and explained the purpose of the visit. The investigation consisted of file reviews, and interviews with relevant parties.

Allegation #1 "Resident's cigarettes are taken away by staff when the resident has behavior issues". The reporting party (RP) alleged that resident #1 (R1) cigarettes were taken away by facility staff whenever they had behavior issues. LPA interview with the Licensee revealed that R1's physician recommended that they stop smoking. The Licensee also stated that a plan was developed with other outside agencies to help reduce R1's smoking, and R1 agreed. The Licensee further states that eventually, R1 no longer wanted to cooperate with the plan, and it ended. LPA interview with R1 revealed that R1 acknowledged that the Licensee restricted their cigarettes and then gave the cigarettes back. LPA file review revealed that R1's physician recommended that R1 stop smoking. LPA file review also revealed that the facility staff was helping R1 decrease their daily number of cigarettes. The finding is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230207154955

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: VILLA'S ADULT RESIDENTIAL HOME	FACILITY NUMBER: 361880736
	VISIT DATE: 02/22/2023

NARRATIVE

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Allegation #2 "Resident's outings are taken away by staff when the resident has behavior issues". The RP alleged that R1's outings are taken away whenever they have behavioral issues. LPA interviews with the facility staff revealed that R1 does go on outings. LPA interview with R1 revealed that the residents in care only go somewhere once they have good behavior. LPA interview with resident #2 (R2) revealed that the facility staff does not take away their outings when they have behavior issues. The finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Staff pulls residents hair”. The RP alleged that a facility staff member pulled the resident’s hair. LPA interviews with facility staff revealed that no one witnessed facility staff pulling residents' hair. LPA interview with R1 revealed that they witnessed facility staff pull another resident's hair. The finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation # 4 “Staff does not treat resident with dignity and respect”. LPA interviews with facility staff revealed that all interviewed members of the facility staff deny not treating residents in care with dignity and respect. LPA interview with R1 revealed that R1 could not provide an example of facility staff not treating them with dignity and respect. LPA explained the definitions of what the words "dignity" and "respect" to R1, and R1 stated that someone working at the facility laughed at a health issue they had. LPA interview with R2 revealed that they have no issues with residing at the facility. LPA interview with R2 further revealed that the facility staff is nice to them. The finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and copy of this report was provided.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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